The pandemic has put public health up, front and centre in the national consciousness. As an immediate response, public health leaders pushed the powerful line: ‘Stay Home, Save Lives, Protect the NHS' and secured compliance with social distancing and separation to reduce risk, illness and death.
The narrative worked, but it has created anxiety and hypervigilance about social contact and the feeling that other people pose a threat to our wellbeing. As lockdown is eased, some people will overcome these feelings and reconnect with the social world. But many people will continue to regulate their proximity to others and worry about repeated spikes.
On top of this, the rest of 2020 will bring increased mental health distress. Thousands will lose their jobs, possibly their homes, and winter will bring more loneliness due to localised lockdowns.
What should public health leaders do, when faced with these complex and urgent challenges?
Learning from crisis
At Innovation Unit, we wanted to find out how the mental health system responded to the crisis. We have learnt a great deal about the system from our work in managing Living Well UK programme, funded by the National Lottery Community Fund, which is helping to create preventative, holistic, community-based ‘front doors' to mental health in four pioneering places in the UK.
We carried out in-depth interviews to gather perspectives on how the current system responded to COVID and what kind of future system people wanted. We interviewed 28 people across the UK - those with lived experience of poor mental health, front line professionals, managers and leaders, and academics and commentators.
What did people tell us?
We heard, most clearly, a case for personal relationships and social networks in sustaining good mental health, and a compelling vision for informal, public spaces where people can simply be together to share their difficult experiences and moments of hope.
From our research, and the Living Well UK programme, it's clear that people often need simple, practical help with everyday problems as well as spaces for open conversations. This challenges the idea that the system response has to be formal services.
Many people told us about their desire to offer support. We've already seen communities stepping up to provide care during the crisis, nearly a million people volunteered with the NHS. Informal support will be even more important in the time ahead.
This got us thinking: how can we enable citizens in communities to help each other in the coming months? How can we help build connection, trust and compassion in place of separation, distancing and distrust? And how can we do this when individual, family and community resilience is likely to be severely tested as we approach winter?
We need bold, fast-paced action in public mental health
Public health leaders and their partners need to do three things to build community resilience - and fast.
- Mobilise local communities and civic action to support the most vulnerable groups, as furlough ends and winter approaches. Inspiration can be taken from the Government's call for NHS volunteers to mobilise volunteers in local places, ready to help vulnerable people with practical and emotional support.
- Create new networks of community spaces such as barbers, libraries and cafes, that are mental health informed and offer compassionate conversations. People can talk about their mental health without referrals or thresholds, based on the core principle that communities are made up of people who both give and receive support. There are a few places like this already; Frazzled Cafes, and the Lions Barbers Collective, for example. Too often they are small pockets of excellence in an ocean of need. We need to work fast to set up community spaces across the country.
- Invest in programmes that build people's capacity for self-care and care for others. Through our research and wider work in mental health, we know we live in a society where people find it difficult to wish themselves and others well. New, evidence-based initiatives for building our internal systems for self-care are available, and need to be scaled to new places.
What do these three suggestions have in common? They each recognise the importance of culture in determining health and wellbeing - how we live, work and play. Services are important, but as our research confirms, for too many people they are hard to access and on their own will never meet the increased demand of a post-COVID world.
We must devise new solutions that at least limit the damage and at best open up meaningful and fulfilling care and support to everyone. Putting people and communities in control of mental health has to be fundamental to the next phase of our crisis response.
Read the report: From crisis to renewal: redesigning the mental health system around people and communities.
Innovation Unit is a social enterprise that grows new solutions to complex social challenges. By making innovation happen we help create a world where more people belong and contribute to thriving societies. We build alliances with ambitious places, organisations and systems around the world to adapt, adopt and scale innovations that deliver lasting impact and reduce costs.
To work with us, contact lwuk@innovationunit.org
Nick Webb is lead for innovation in mental health at the Innovation Unit
